First Do No Harm Read online

  “Ten-four, Delta three-five. Can you give a description of the man?” asked Nicole.

  “This guy is in his mid-thirties, clean shaven, well-dressed, clean baby-smooth hands. He's stoned out of his mind on some super speed drug but he’s not seen a minute of hard work all his life. He has a few fresh needle marks on his left arm; it looks like he’s been shooting up,” noted the police officer.

  “Nicole, I heard all that. That’s him. Tell them I’m on my way. Don’t leave the scene until I get there. I only live a few minutes away,” Susan spoke hurriedly. The phone line went dead.

  *****

  9:04 PM

  The trees, bushes and flowers around 3076 Bell Road glowed intermittently with the multiple blinking red, blue and white lights and strobes over the three police cars parked in disarray.

  The assailant continued to wrestle with the officers. The two older policemen, sergeants Pedro Sanchez and Penny Newman, held up flashlights, provided radio communication as necessary and gave general directions to the other four cops. Among them was a rookie named Alfred Smyth, who had joined the force five weeks earlier. He was well built and quite capable of contributing to the might required to subdue the assailant. But Officer Smyth was nervous about the whole affair. This was his first real situation, as he would later call it. He had taken the time to release the safety strap holding his handgun in the holster. As he attempted to subdue the agitated man, Al mentally rehearsed the steps required to put two bullets between the perp’s eyeballs, should the restraining process suddenly prove inadequate. For now, the crazed man was on his stomach, his movements restrained. He groaned like a furious animal. Three of the officers held him down while a fourth attempted to place a protective vest on him. An attempt to handcuff the man was unproductive, as the thug fought like a big fish out of water.

  The goon could not be reasoned with by the police officers. No way, no how. He was fighting like his life depended on it. He wanted to kill or be killed. It didn’t seem to matter to him.

  As the ambulance sirens were heard over the dead of night, the aggressor suddenly hyped up, his energy unexpectedly heightened. This occurred at the unfortunate exact time that the officers let up for a split second, their attention drawn to the approaching EMS vehicle. This allowed Jack Norris to jerk free and get up on his feet. He groaned loudly and prepared to attack, a rush of madness entering his body out of nowhere.

  As the others prepared to re-engage in the restraining process, Officer Alfred Smyth stood back straight, feet comfortably apart, his Smith & Wesson .357 Magnum drawn with the madman’s forehead inside his front and rear sights, safety latch released. As he had done so often at the Police Academy only a few weeks earlier, Officer Smyth took a deep steadying breath and prepared to gently squeeze the trigger.

  “No!” exclaimed Sergeant Newman loudly as she heard the hushed click, click, click of the retreating hammer and rotating cylinder. This yell alerted all the officers, who reflexively looked at Al. So did Jack. But unlike the others, Jack remained clueless to the grave peril ahead.

  “Don’t shoot,” commanded Sergeant Sanchez, taking long steps towards the young police officer.

  The ambulance arrived at the scene, while the evening stillness was suddenly assaulted by the deafening sound of a gunshot.

  *****

  Over a year ago

  July 8

  10:14 AM

  Dr. Ian Rupert entered the research laboratory. As the door closed behind him, the tension in the department became almost palpable. He strutted towards the animal laboratory. The workers smiled and greeted him politely as he strode by—some out of respect, most out of fear. Dr. Rupert was an influential man who was world-renowned in the field of research especially, that which involved cardiac investigation. He was a middle-aged, tall, lean, gray-haired, distinguished looking man, whose work had contributed significantly and often to the medical literature. He was in charge of the research department at the Medical School in Indianapolis. As such, he commanded a lot of respect. When Newton Memorial was designated as the major research hub of the medical school, Rupert moved his office to the hospital in Evansville, leaving behind the large campus of the mecca that was the great medical school in the capital. Besides a full complement of research PhDs, MDs, techs and assistants, Dr. Rupert had under him several research fellows, doctors-in-training that pursued the acknowledgment of having worked under the tutelage of the great professor. The research department cranked out multiple scientific papers, in many fields of medicine, giving the school a reputable name and recognition in the medical world.

  With an air more fitting of a Roman emperor than that of a modern-day department head, Rupert sauntered toward the back of the laboratory passing by busy employees who took turns greeting the director. With every few steps, he would fake a smile and slightly nod his head, in response to the venerations.

  The odor in the animal lab was distinct and unmistakable. It was a combination of animal urine and feces intertwined with the mixed scents of cedar chips, chlorine bleach, air deodorizer and God knows what else, used in a feeble attempt to mask the stench. Multiple small-animal cages were on display throughout the large room. Rupert entered a smaller area inside the animal lab, pushing past a door labeled Cardiovascular Research. Just beyond the door, a group of scientists in white lab coats gathered around several small cages. Each cage was marked with a sign, LFJ659, and contained four rats, one tagged with an ankle bracelet. Underneath the large print label, the signs also indicated, in smaller print, the dosage that had been administered to the marked rat in the cage. The research team was somberly discussing and documenting the results.

  “How are these beauties doing today?” asked Dr. Rupert regally of no one in particular, as he approached. None uttered a word, but their body language spoke volumes, all eyes fixated on the contents of the cages in front of them. There was a sense of failure and sorrow for the animals. The initial smile on Rupert’s face faded rapidly. The small creatures in the cages were all dead.

  “Cut down the damned dose even more. It’s still too high. Do you know how much damned money and time is invested in this drug? Right now, this stuff is nothing but rat poison. And find out why the damned control rats are dying. Let’s get more rats in here and this time let’s get some results,” shouted Dr. Rupert angrily with obvious disappointment and annoyance in his voice.

  “Clean up this mess,” he commanded as he turned around, departing the area. The door slammed closed with a crash behind him.

  *****

  Nine months ago

  January 6

  3:14 PM

  Dr. Ian Rupert sprawled comfortably in his lazy chair, his feet up and his left hand around a snifter of warmed cognac, which he sipped occasionally. In his right hand, Dr. Rupert spoke calmly but confidently into a handheld recorder in between making expressive pantomimic faces after a sip of the exquisite spirits. His recorded voice would soon be plugged into his laptop and replayed, allowing for a computer-driven automatic transcription, which would be saved on a thumb-drive. Rupert would meticulously and obsessively document the progress of every research endeavor, the newest of which was a drug under development in the hopes of helping patients with congestive heart failure. After several months, the experimental potion he termed Rat Poison had started to show a glimmer of promise. His previous worries about the experimental drug LFJ659 were now behind him, with the promise of smooth sailing ahead.

  “Research protocol LFJ659. January 6, 2006.” Rupert would always start his dictations in this way. After a quick moment to gather his thoughts, he pressed the Record button again and continued to speak into the microphone:

  We have finally derived the appropriate dose. At a dose of 0.00025 micrograms per kilogram, the CHF rats given LFJ659 were able to exercise significantly longer than the control rats. Furthermore, as compared to the control animals, those given the experimental drug were able to exercise longer and experienced less heart rhythm disorders. These results have b
een consistently predictable over a period of up to two weeks. No death occurred at this dose. We will start a long-term experiment with LFJ659 looking at exercise tolerance, exercise capacity, arrhythmia burden and the incidence of sudden cardiac arrest. Once we evaluate the long-standing effects on the rodent CHF model, we will progress to the human phases. This is very exciting work with a lot of promise for the future management of the CHF patient.

  Rupert paused and took another sip of cognac. One more obligatory facial expression of pain, as the spirits slid down, flaming his esophagus. He got up slowly and walked toward his elegant desk.

  “Donna, arrange a meeting for tomorrow morning at ten o’clock with Dr. John Connor and James Miller to discuss the next phase of Rat Poison. Have John begin to work on the IRB forms and process,” commanded Rupert, authoritatively pressing the intercom button. Just outside the door, Donna, his secretary, quickly acknowledged the request. He sat back comfortably in his lazy chair.

  “This drug is going to make me rich and famous,” he said. This time he had not pushed the Record button. Instead, he put the Dictaphone down on the table next to his chair. He smiled and took the last particularly big gulp of cognac. The face again. This time, he ended it with an Aaaahhhh of contentment.

  *****

  Eight weeks ago

  August 3

  7:59 AM

  Dr. Jack Norris arrived at Meeting Room Three. He looked around the room and took his usual seat in the front. For a thirty-one-year-old doctor in his last year of training, Jack had accomplished quite a lot. His superior intellect had been obvious to those in charge, who bestowed upon him the title of Chief of Cardiology Fellows. His duties would consist of dealing with the everyday routine of supervising the training of young doctors and medical students.

  This morning, like all others, Morning Report would start at eight o’clock in the morning. He would meet with all the resident doctors and medical students rotating through the cardiology service and discuss the cases admitted during the on call period, which began at five o’clock the evening before.

  Meeting Room Three contained many seats, which gave it the appearance of a classroom. On display were several X-ray viewing boxes, a large blackboard and a retractable screen, which would be used to display images from an old-fashioned projector or PowerPoint presentations. A podium was to be used by the presenter.

  The room was filled with eighteen young doctors in training, ranging from first-year interns to third-year medical residents. Also present were cardiology and electrophysiology fellows and twelve medical students, three of whom were complete newbies, today being their first day. They were the students assigned to Jack’s group for the next two months on their cardiology and electrophysiology elective rotations.

  “Let’s see the list, George. How many hits did you get last night?” asked Jack.

  “We admitted five patients. Here’s the list,” replied Dr. George Snyder, a second-year cardiology fellow who was in charge of the on call team the evening before. George was a short balding man who appeared much older than he really was, especially today with his unshaven face. His hair was short and dark. His eyes were brown and piercing.

  As he perused the list of the five admitted patients, Jack announced, “Before we begin, let’s welcome the three new med students. They will be with us for the next couple of months. Dr. Snyder, do you know the difference between medical students and a pile of dog shit?”

  “Nobody goes out of their way to step on a pile of dog shit,” answered all the residents monotonously, slowly and in unison. Their tone of voice indicated plainly that this joke was as old as dirt.

  “No, no, no. Dog shit is crap. Medical students are invaluable members of our mean and lean team. They’re here to help us and to learn under our tutelage; let’s teach them,” said Jack with jocularity.

  After a few chuckles, everybody quieted down. On the viewing boxes hung X-rays showing two views of someone’s chest, the most prominent shadow of which was the large cardiac silhouette.

  Jack broke the silence. “Let’s start this morning report." Jack scanned the list of admissions one last time. “Let us hear about Mrs. Lucille Hart. What is wrong with Mrs. Hart’s heart?”

  George Snyder was in charge of the presentation. He gathered his notes and walked to the podium. Another of the young resident doctors, Dr. Mary Taylor, a medical intern, got up and placed Mrs. Hart’s X-rays on the view box then sat back down. By then, George was ready to start. As he spoke, Mary placed a copy of the presenting electrocardiogram on a projector displaying it on the screen, which another resident had lowered into position.

  “Mrs. Hart is a sixty-one-year-old woman who has a history of heart disease with a known cardiomyopathy, an ejection fraction of thirty percent and recurrent admissions for congestive heart failure who presented with a tachycardia at a rate of 180 beats per minute. The EKG is shown here,” George said, pointing to the large projection on the screen.

  “Let’s ask one of the medical students to decipher this mess for us. Who wants to go first? Start by telling us what a cardiomyopathy is, what the ejection fraction means, and what a tachycardia is?” interrupted Jack, as he looked about the room for volunteers.

  “Cardiomyopathy is a general term indicating a dysfunctional heart. The ejection fraction is a measure of how well the ventricle pumps and the percentage of blood pumped out with each beat. Normal is fifty to sixty percent. Tachycardia is a rapid heartbeat disorder. This one is ventricular tachycardia,” responded one of the students proudly.

  “Very good,” Jack said. “You are—” he asked, pausing for an answer.

  “Peter Joseph, sir,” answered the medical student nervously. He was one of the new arrivals.

  “Okay, Mr. Peter Joseph Sir, why do you think the rhythm is ventricular tachycardia?” inquired Jack.

  Peter smiled nervously, hardly aware that some of the others chortled from the way Jack called out his name teasingly. He was a young looking twenty-four-year-old, intelligent and highly motivated third-year medical student who had recently declared to all his classmates he was pursuing a career in cardiology. He loved to study the intricate workings of the heart and felt most comfortable with cardiac disorders. Before his arrival, Peter read many chapters in Braunwald’s Heart Disease, Textbook of Cardiovascular Medicine, the bible of cardiology. He spent a great deal of time reading the chapter on myocardial infarctions, or MI, to review the mechanisms, physiology, and management strategies in the treatment of heart attack victims. During his reading, he came across the differential diagnoses of heartbeat disorders, including tachycardia, or rapid heartbeat disorders, some of which can be lethal. He wanted to shine during this month and since his mentor was an electrophysiologist, Peter wanted to know as much about arrhythmias as he could. He sought after excellent recommendation letters, a necessity if he was going to be accepted into a good cardiology program. Many had told him that he should not make this specific a decision so early in his career. After all, he still had to take many rotations and pass many exams in all the other disciplines of medicine, including pediatrics, surgery, psychiatry, and obstetrics and gynecology. He didn’t care. His plan was to study it all just enough to pass the board exams and live through painfully long one-month rotations through the other services. These next two months were going to cover that which he loved most, cardiology and electrophysiology.

  “Well, a previous heart attack would have provided Mrs. Hart with a heart muscle scar which is necessary for electrical reentry in the ventricle and to produce ventricular tachycardia. Other mechanisms of tachycardia would be rare given this presentation,” answered Peter.

  “Good job. You are absolutely right,” said Jack. “Go on with the case, George.”

  “Mrs. Hart presented with severe shortness of breath, chest pains and dizziness. We were called stat to the emergency department and decided to cardiovert her to sinus rhythm, which we did successfully after intravenous Brevital for anesthesia,” continued George.r />
  “Pete, will you give us a 10 minute talk on Brevital anesthesia tomorrow?”

  Peter nodded silently.

  “Who wants to report on other therapies for the acute management of ventricular tachycardia?” Another student raised his hand and Jack nodded accordingly acknowledging the assignment. “What is your name?” he asked the student.

  “I’m Christopher O’Neal, sir,” answered the medical student. Just like Peter, Christopher was a third-year medical student of the same age, but unlike Peter, he detested cardiology. He thought it too cerebral. He preferred talking to people, instead of sticking tubes into their arteries and veins. He was considered the token psychiatrist of the bunch. He hadn’t made up his mind yet about which branch of medicine he liked, but he knew he didn’t want cardiology. As such, he dreamed of fast-forwarding through this rotation. Having met his mentor, Dr. Jack Norris, Christopher actually thought he was going to bear the cardiology cross relatively well. Christopher was plump and always happy with a big grin on his face that, at times, had gotten him in trouble.

  “Oh, your last name is Sir, too. Are you twins?” asked Jack with a smirk. Jack gestured to the presenter to carry on.

  “Her meds prior to admission were digoxin, one-fourth milligrams daily, and Lasix, forty milligrams twice daily,” George said, continuing with the case presentation.

  “Yikes, what’s wrong with this picture? And tell us your name,” asked Jack, of the third new medical student.

  “I’m Taylor Twelly, sir. We’re triplets.” All laughed. “What’s wrong with this picture?” repeated Taylor, pensively.